ECF

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The chemotherapy treatment you are to receive uses three drugs and these are called Epirubicin, Cisplatin and 5Fluorouracil (ECF).

These drugs are given through a small and very thin plastic tube (Hickman or Groshong line), which is inserted under local anaesthetic into the vein that lies just behind your collar bone. The end of the line comes out as a short piece of tubing on your chest wall. You may be asked to stay in hospital overnight. You will have a chest X-ray to make sure its is in the correct position, and you may be asked to take a Warfarin tablets to reduce the chance of the line causing a blood clot. You will be taught how to care for your line and it is important that you carry out the care properly. You will be taught how to do this by the chemotherapy nurses.

You will be carefully monitored by the chemotherapy nurses. You will usually be given up to six cycles of Epirubicin and Cisplatin at three weekly intervals, and the 5 Fluorouracil is given as a continuous infusion using a small portable pump, which you can wear over your shoulder or on your belt. You will be required to return to the department each week to re-fill the pump.

Listed below are some of the more common side-effects associated with your chemotherapy. These are an overview of the common side-effects you may encounter. However, you may experience none, all or only a few of these. If you become aware of any other side-effects, please report them to your clinic.

Side effects

Nausea & sickness; Despite the anti-sickness medication given with your chemotherapy and for a few days afterwards, some nausea may occur. This is usually associated with reduced appetite and in some cases vomiting. If marked you should contact the cancer unit for help as its important you do not get dehydrated. Some cancer units prescribe anti-sickness suppository to take home and should be used if sickness occurs. In general, anti-sickness tablets should be taken regularly and are usually successful, but if you do have problems, different  tablets can be prescribed for the next cycle. Some self help tips may also be useful.

If your blood counts falls you may experience the following:

Other advice on paracetamol; As mentioned above, if you have a temperature and feel unwell you may have an infection and may need treatment in hospital, we advise not to take paracetamol in this situation as it may mask your temperature, give false reassurance and delay you presenting to hospital for treatment. Taking paracetamol can otherwise be used with discretion. If for example you have a headache or a mild pain but otherwise feel well and your temperature is normal paracetamol can be used provided you check your temperature before each dose and allow a full six hours before each administration.

The Epirubicin injection is coloured red. You may notice that the first time you pass urine after chemotherapy it is coloured red. This is normal.

You should try to drink plenty of fluids (other than tea and coffee) at the start of chemotherapy and for the next 24 hours.  

Contact to chicken pox; If you can't remember whether you've had Chicken Pox as a child and you come in contact with a person who as it or shingles you should contact your oncology team. They will arrange a blood test to find out if you are immune to chicken pox (the varcella virus). If not a series of injections can be administered to offer you temporary immunity

Fatigue; All chemotherapy can cause fatigue. As your treatment progresses you will experience this. You may find that gentle exercise such as a short walk each day (if you are not working) may help.  Fatigue and malaise may last up to 2-3 months (or longer) after the end of chemotherapy. 

Weight gain; Over the entire course of chemotherapy many patients complain of weight gain. This is caused by a combination of the steroids increasing the appetite, the fatigue causing lack of mobility and the mild nausea often encouraging to nibble rather than eating correct meals - In order to prevent this we recommend regular light exercise and be aware of your calorie intake.

Weight loss may also be experienced by some patients during their course of chemotherapy particularly if there is more advances disease or other medical problems, in these cases dietary advice should be sought.

Sore mouth; You may have a sore mouth after chemotherapy and it is important that you maintain good oral hygiene. A soft, baby toothbrush may help and you may be given a mouthwash. If you develop mouth ulcers you should contact your clinic and they can prescribe special mouthwashes to help. You may also be given tablets called Folinic Acid to take after chemotherapy, especially if you have had any problems with a sore mouth. These tablets are started 24 hours after the injections.

Hair loss; This chemotherapy usually causes mild hair loss. It usually starts 3-4 weeks after the first course and may be lost completely. You may also experience thinning and loss of eyelashes, eyebrows and other body hair. This is temporary and your hair will regrow after treatment, although it may at first be a different texture, very like a baby's hair. Some departments use a cold cap system to minimise hair loss. Your clinic nurse can arrange for you to have a wig before your treatment starts (NHS prescription charge, prices are approximately 55 for an acrylic wig, 140 for half real hair wig and  205 for a full real hair wig).  

Premature menopause; For pre-menopausal women, chemotherapy may affect your periods. They may become heavier, lighter or may stop. In some women this may be permanent causing menopausal symptoms.   You should not become pregnant during chemotherapy, as chemotherapy will damage a growing baby. You should still take contraceptive precautions even if your periods have stopped, as you could still become pregnant. 

Constipation; Some patients experience constipation which may be due to the anti-sickness tablets. You should drink plenty of fluids, eat a high fibre diet and take gentle exercise. If this is severe you should contact your clinic or GP. 

Steroids; This chemotherapy is given with steroids (e.g. Dexamethasone) to help prevent sickness. Steroids have some side effects, including fluid retention, weight gain, wakefulness and sometimes agitation. If you suffer from  indigestion you may be given tablets to prevent this. If patients are prone to "spots" or acne this can be made worse. Likewise they can temporarily upset diabetes or high blood pressure.

Diarrhoea; This chemotherapy can cause diarrhoea, which can be easily controlled with medicine, but you should inform your doctor if it is severe or continues. It is important to drink plenty of fluids if you do get diarrhoea. If you have any alteration in bowel pattern tell your doctor.  

Altered sensation; This chemotherapy can irritate the nerve endings and some people notice altered sensation with slight numbness, or pins and needles in the fingers or toes. This comes on slowly, is usually mild and will usually get better slowly after chemotherapy has finished. If the numbness is severe it may interfere with fine movement  (e.g. fastening buttons). If you develop sudden numbness or weakness this should always be reported immediately. 

Altered taste; You may also experience an alteration in your taste. Food may taste slightly more salty, bitter or metallic. Normal taste will return once you treatment has finished, but may take several months to do so.   

Damage to kidney function; This chemotherapy can interfere with the function of your kidneys. This will be monitored with blood tests before each cycle and often a more sensitive test before the start of Chemotherapy.

The drug, 5 Fluorouracil, can cause the skin on your hands and feet to become reddened and sore. This will be closely monitored and changes can be made to your treatment to treat it.

Your veins Three types of damage can occur, listed in order of seriousness:

Increase risk of blood clots - during chemotherapy there is an increased risk of blood clots, most commonly in the legs (deep vein thrombosis) or more seriously to the lungs (pulmonary embolus). If you get unexplained swelling and discomfort in the calf report this to the oncology unit. Likewise if you start experiencing unexplained breathlessness, cough up any blood or have a pain in the chest particularly when you breath contact the clinic as soon as possible. To avoid clots its important to stay as active as possible and (exercise & chemotherapy) taking light walks two to three times a day and avoid sitting around for long periods of time. If you are required to sit (for example while receiving the chemotherapy drugs) try to move your legs and ankles regularly. Occasionally, if your doctor feels you are at high risk of developing clots you may be started on drugs to thin your blood during chemotherapy.  

Sore eyes; The front of the eyes (cornea) can occasionally feel dry and sticky, especially first thing in the morning. This usually comes on later in the course and can cause some redness and discomfort. Eye drops such artificial tears can be bought over the counter or prescribed by your medical team. 

Nails; The grow of the nails can be impaired by chemotherapy. The amount of damage can vary but in most case there will be some slight discolouration and indentation seen in ridges across the nail beds - a bit like the rings of a tree, each representing an individual chemotherapy cycle. Occasionally the damage can be more troublesome, causing pain and breakdown of the nail bed causing it to lift and separate, possibly even leading to a total loss of the nail. Eventually after chemotherapy has finished the nail will grow back normally.

Further general information Your doctors and specialist nurses are in an ideal position to give you relevant information on your disease and treatment as they know your individual circumstances. Cancerbackup has a help line (0808 800 1234) and a prize winning video available in English, Italian, Urdu, Bengali, Gujarati & Hindi explaining Radiotherapy & Chemotherapy. Cancernet.co.uk has over 500 pages describing cancer, its management, practical tips and tool which patients, their carers and their doctors have found helpful during the cancer journey.



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